Measurement of carbon dioxide in blood

The remarkable combination of physical and chemical properties displayed by carbon dioxide has enabled the development of a very wide variety of analytical methods for its measurement in blood or blood plasma. Both for historical and technical reasons, the gasometric method of Van Slyke and Neill is preeminent, but great skill is needed to realize its full precision and accuracy. The microgasometer of Natelson, however, has served the clinical laboratory well as a practicable manual means of microanalysis for total carbon dioxide. So far as automated analysis is concerned, it is highly significant that one of the first applications of Skegg's continuous flow principle was to the titrimetric determination of total carbon dioxide in serum; the AutoAnalyzer technique remains the most widely used of its kind, in spite of inherent difficulties in specimen handling, instrumental standardization, and quality control. At the same time, it has been pointed out that the routine determination of total carbon dioxide in serum does not offer a useful screening procedure for identifying or characterizing patients with acid-base disorders; full assessment of acid-base status, including pCO2 in selected patients is much more rewarding. The credit for bringing pCO2 measurements within the scope of the clinical laboratory, by means of the interpolation technique, is largely due to Astrup and his colleagues. Nevertheless, continual improvements have been made in the design and performance of the Severinghaus type of pCO2 electrode, so that reliable instruments offering direct readout of blood pCO2 are available from several manufacturers. The more elaborate versions of these instruments are rugged and work-simplified, and they offer automated self-calibration and end-point detection for pH and pO2, as well as pCO2. It will be surprising if such instruments do not come into widespread use.